The California Supreme Court gave gay rights advocates a major victory in May, ruling the state’s constitution guarantees same-sex couples the same marriage rights as opposite-sex pairs. Thousands of same-sex couples from California and around the country have already taken advantage of the decision to obtain legal recognition from California for their unions. Opponents, however, have placed on the state’s Nov. 4 ballot a constitutional amendment that would deny marriage rights to same-sex couples by defining marriage as the union of one man and one woman. Similar proposals are on the ballot in Arizona and Florida. The ballot-box showdowns come as nationwide polls indicate support for some legal protection for same-sex couples, but not necessarily marriage equality. In California, one early poll showed support for the ballot measure, but more recently it has been trailing. Opposing groups expect to spend about $20 million each before the campaign ends.

* Should same-sex couples be allowed to marry? * Should state constitutions prohibit marriage for same-sex couples? * Should states recognize same-sex marriages from other states?

Protecting WetlandsThe nation’s millions of acres of wetlands provide vital protection to the environment. Ponds, lakes, swamps, bogs, bays and marine estuaries not only shelter countless fish, birds and animals but also filter pollutants from water and soak up floodwaters. Since the nation’s beginning, more than half of its wetlands have been lost, and crucial areas like Louisiana’s coast and the Florida Everglades are eroding daily. Although the U.S. actually has achieved small net gains in wetlands in recent years, scientists say the nation is still losing too many needed wetlands. For several decades national policy has called for protecting wetlands, but powerful industries such as construction, energy and agriculture say current regulations make projects more expensive. Conservationists, sportsmen and many state officials respond that regulation is still urgently needed. Meanwhile, recent Supreme Court decisions have intensified debate over how broadly the federal government can oversee activities affecting wetlands.By Jennifer Weeks

Affirmative ActionAffirmative action has sunk deep roots in American higher education, government and business. But tension still runs strong between the ideal of choosing school and job candidate purely on merit, and requirements to factor in other criteria – including race. This November, ballot initiatives in at least two states would eliminate race, but not socioeconomic, preference. And big states including California, Florida and Texas are still struggling to reconcile legal mandates restricting the use of race in college admissions with the goal of increasing diversity. One stumbling block: Affirmative action didn’t lessen the stunning disparities that plague elementary and high school education, disparities that often follow the color line. Still, the open racial hostility that marked opposition to affirmative action decades ago has faded. Even some race-preference critics don’t want to eliminate it entirely. Instead, they’re exploring ways to keep diversity without eroding admission and hiring standards.By Peter Katel

Financial System BailoutIn the wake of widespread failures on Wall Street – including the federal bailout of insurance giant American International Group and the bankruptcy of venerable investment bank Lehman Brothers – Congress was poised to approved a $700 billion bailout proposed by Treasury Secretary Henry Paulson and Fed Chairman Ben Bernanke. But even as the plan was moving toward apparent approval, many were questioning whether the bailout would stem the financial crisis that grips not only the United States but the global banking system. They also were asking whether the costs of the bailout to U.S. taxpayers would be excessive, and whether Congress will have to take further action to correct the nation’s systemic financial problems. By Thomas J. Billitteri

Sen. John McCain, R-Ariz., announced he would put his presidential campaign on hold to join his congressional colleagues in drafting a $700 billion financial bailout bill. McCain also called on his opponent, Democratic nominee Sen. Barack Obama, D-Ill., to join him in postponing their first debate on Friday. Obama, who recent polls have shown to be more trusted by Americans to fix the economy, said he would attend the debate and would not suspend his campaign, warning that injecting presidential politics into negotiations over the bailout bill could be more harmful than helpful. Both McCain and Obama planned to meet on Thursday with President Bush to discuss the proposed bailout, which congressional leaders said early Thursday afternoon they were close to finalizing.

Northwest and Delta airlines announced plans to combine their domestic and international networks, creating a single, vast $17.7 billion airline company – the world’s largest. The global giant would have more than 800 jets, 6,400 daily flights and nearly $32 billion in annual revenue. Delta is the leading U.S. airline in the trans-Atlantic market and has strong domestic routes in many parts of the country. Northwest is a leading U.S.-Asia carrier with a formidable presence in the upper Midwest. Yet to be approved, the new airline will be named Delta and headquartered in Atlanta, with major hubs in Atlanta, Detroit, Minneapolis/St. Paul, New York, Amsterdam and Tokyo.

Jennifer Pizer and Doreena Wong met on their first day at New York University Law School in 1984. They graduated in 1987 and moved to California together three years later.

Jenny and Doreena were still together on May 15, 2008, when the California Supreme Court issued its stunning, 4-3 decision establishing a constitutional right to marriage for same-sex couples in the state. As one of the Lambda Legal Defense and Education Fund lawyers in the case, Pizer spoke at a press conference in San Francisco after the decision was released and then flew home to Los Angeles for a rally in the heart of gay West Hollywood.

“You’re not going to do anything funny, are you?” Doreena asked Jenny in the car as they drove to the rally. Pizer feigned ignorance even as she was thinking that the event was the perfect time to pop “the question.”

So, as she finished her remarks, Pizer looked down toward her partner’s face in the crowd and said, “Now, I’d like to ask a question I’ve waited 24 years to ask: Doreena Wong, will you marry me?”

“Yes, of course,” Wong replied. Standing at the microphone, Pizer relayed the answer to the cheering crowd: “She said yes!”

Television cameras recorded the moment, but Pizer admits months later that she has yet to see the full video clip. For even as gay rights advocates are celebrating the victory – and Jenny and Doreena are planning their Oct. 5 wedding in Marin County – opponents of gay marriage are working hard to reverse the state court’s decision.

Less than three weeks after the decision, opponents won legal approval to put a state constitutional amendment on the Nov. 4 ballot that would allow marriage in California only “between a man and a woman.” If accepted by a simple majority of the state’s voters, Proposition 8 would prohibit marriage for gay and lesbian couples in California and bar recognition of same-sex marriages from other states as well.

“Marriage has always been understood as the union of one man and one woman by California citizens and by other people in the country,” says Mathew Staver, founder and chairman of Liberty Counsel, a Christian public-interest law firm, and one of the lawyers who argued against gay marriage before the California Supreme Court. “That provides the best environment for society.”

“We absolutely agree that marriage is a special word for a special institution,” Pizer responds. “We disagree that the social institution should be available only in a discriminatory manner and that it serves any social purpose to exclude gay and lesbian couples.”

The debate over the ballot measure has not deterred but in fact has encouraged gay and lesbian couples in California to get to the altar – or to city hall. By one estimate, some 5,000 same-sex couples got married in California within the first week after the court ruling became effective on June 17. The first-week spike receded, but the weddings are continuing – spurred by the widespread assumption that marriages performed before Nov. 4 will remain valid even if Proposition 8 is approved.

Hollywood celebrities have been among those tying the knot, including TV talk show host Ellen de Generes and ex-”Star Trek” actor George Takei. De Generes wed Portia de Rossi, her girlfriend of the past four years, in an intimate, picture-book ceremony at their Beverly Hills home on Aug. 16. Takei and his longtime partner Brad Altman exchanged self-written vows in a more lavish ceremony at the Japanese American National Museum in downtown Los Angeles on Sept. 14. “May equality long live and prosper,” Takei said as he left the ceremony amid a horde of photographers and well-wishers.

Most of the newlyweds, however, are non-celebrities, many of them in long-term relationships that had already been registered under a 2003 California law as domestic partnerships with nearly complete marriage-like rights and responsibilities. “There’s almost no change” over domestic partnership status, explains David Steinberg, news desk copy chief at the San Francisco Chronicle, who married his longtime partner Gregory Foley in July. Steinberg says he and Foley, a nurse at Kaiser Permanente, decided to get married anyway “because they might take it away.”

The state high court decision made California the second state, after Massachusetts, to allow marriage for same-sex couples. The Supreme Judicial Court of Massachusetts issued a 4-3 decision in November 2003, holding that the state had “no constitutionally adequate reason” for denying same-sex couples the legal benefits of marriage. The court gave the legislature 180 days to respond but later issued an advisory opinion saying that civil union status would not be an adequate substitute for marriage. When the legislature failed to act by the deadline, the high court decision took effect, and same-sex marriages began in Massachusetts on May 17, 2004.

The California Supreme Court ruled similarly but more directly that the state’s constitution guarantees a “fundamental right to marry” to “all Californians, whether gay or heterosexual, and to same-sex couples as well as opposite-sex couples.” The majority opinion – written by the Republican-appointed chief justice, Ronald George – specifically rejected civil union or domestic partnership status.

The ruling invalidated a statutory initiative to define marriage as between one man and one woman approved by slightly over 61 percent of the state’s voters as Proposition 22 in March 2000. Gay marriage opponents had already begun circulating an initiative to write the “one-man, one-woman” definition of marriage into the state constitution. By June 2, they had submitted petitions with approximately 1.1 million signatures – sufficient for the secretary of state to certify the proposed constitutional amendment for the Nov. 4 ballot.

The state Supreme Court added to the urgency of the opposition by declining to stay its decision pending the Nov. 4 vote. Same-sex marriages began in California on June 17. The first marriage license in San Francisco went to two longtime lesbian activists, Del Martin and Phyllis Lyons, who had been together for more than 50 years. San Francisco Mayor Gavin Newsom officiated at the ceremony. Martin died 10 weeks later – at age 87.

Besides Massachusetts and California, eight other states and the District of Columbia permit some legal recognition for same-sex couples, including four that permit civil unions with virtually the same rights and responsibilities as marriage. On the opposite side, 26 states have constitutional amendments that prohibit marriage for same-sex couples, and another 17 have similar statutory bans. In addition, the federal Defense of Marriage Act – known as DOMA – prohibits federal recognition for same-sex marriages. The 1996 law also provides that states need not recognize same-sex marriages from other states.

Massachusetts recorded approximately 11,000 same-sex marriages in the three years after the state high court ruling, according to demographer Gary Gates, a senior research fellow at the Williams Institute, UCLA School of Law. He says an exact count is not possible in California because marriage licenses are no longer recording the parties’ sex, but a projection based on the increased number of marriages in the months after the state high court ruling indicates more than 5,000 same-sex couples married in the first week after the decision.

All told, Gates and his colleagues at the institute – which studies sexual-orientation policy and law, primarily funded by a gay philanthropist – estimate that 85,000 same-sex couples have taken advantage of recognition provisions in those states permitting that status. But a higher percentage of same-sex couples are opting to marry than are registering for civil union or domestic partnership.

Supporters of marriage equality say the growing number of same-sex couples in legally protected relationships is eroding opposition to gay marriage. “We’re seeing a growing public understanding that ending gay couples’ exclusion from marriage helps families and harms no one,” says Evan Wolfson, executive director of Freedom to Marry, self-described as a gay and non-gay partnership advocating marriage rights for same-sex couples.

Opponents disagree. They point to the gay marriage bans already enacted as the better gauge of public attitudes on the issue. “Supporters of same-sex marriage have a real uphill climb if they hope to undo what has been accomplished in the past 10 years by supporters of traditional marriage,” says Peter Sprigg, vice president for policy at the Family Research Council, a Christian organization based in Washington, D.C., promoting traditional marriage.

An initial poll in California indicated the ballot measure was ahead, but statewide surveys in August and September showed the proposition trailing by at least 14 percentage points. Two other states – Arizona and Florida – will be voting on similar constitutional amendments on Nov. 4. Arizona’s measure needs a majority vote; Florida requires a 60 percent vote for a state constitutional amendment.

In addition to those three ballot measures, Arkansans will be voting on a statutory initiative to prohibit unmarried couples – whether same-sex or opposite-sex – to adopt or take foster children. The initiative was proposed after a regulation barring adoption or placement with same-sex couples was overturned in court.

America is rushing to build 670 miles of fencing along the U.S.-Mexican border by the end of the year. The fence – or wall, as critics along the border call it – is to include 370 miles of fencing intended to stop illegal immigrants on foot and 300 miles of vehicle barriers. To speed construction, the Bush administration is using unprecedented authority granted by Congress to waive environmental-, historic- and cultural-protection laws. No one claims that building physical barriers along roughly a third of America’s 2,000-mile Southern border will stem illegal immigration by itself, but supporters believe it is an essential first step in “securing the border,” providing a critical line of defense against illegal migration, drug smugglers and even terrorists. Opponents see it as a multi-billion-dollar waste that will only shift illegal immigrants toward more dangerous and difficult routes into the country, while doing environmental, cultural and economic damage.

* Can a border fence stem the flow of illegal immigrants? * Would blocking all illegal immigrants hurt or benefit the U.S. economy? * Does the fence harm U.S relations with Mexico and other countries?

Gay Marriage ShowdownsThe California Supreme Court gave gay rights advocates a major victory in May by ruling that the state’s constitution guarantees same-sex couples the same marriage rights as opposite-sex pairs. Thousands of same-sex couples from California and other states – since California does not have a residency requirement – have already taken advantage of the decision to obtain legal recognition for their unions. Opponents, however, have placed on the state’s Nov. 4 ballot a constitutional amendment that would deny marriage rights to same-sex couples by defining marriage as the union of one man and one woman. Similar proposals are on the ballot in Arizona and Florida. The ballot-box showdowns come as nationwide polls indicate growing support for some legal protection for same-sex couples, but not necessarily marriage equality. In California, early polls showed support for the ballot measure, but more recently it has been trailing. Meanwhile, marriage-equality cases are pending before state high courts in Connecticut and Iowa, with decisions expected soon. Massachusetts became the first state to legally permit gay marriage, in 2004.By Kenneth JostAffirmative ActionAffirmative action has sunk deep roots in American higher education, government and business. But tension still runs strong between the ideal of choosing school and job candidate purely on merit, and requirements to factor in other criteria – including race. This November, ballot initiatives in at least two states would eliminate race, but not socioeconomic, preference. And big states including California, Florida and Texas are still struggling to reconcile legal mandates restricting the use of race in college admissions with the goal of increasing diversity. One stumbling block: affirmative action didn’t lessen the stunning disparities that plague elementary and high school education, disparities that often follow the color line. Still, the open racial hostility that marked opposition to affirmative action decades ago has faded. Even some race preference critics don’t want to eliminate it entirely. Instead, they’re exploring ways to keep diversity without eroding admission and hiring standards.By Peter Katel

Saving Fannie and FreddieThe federal government’s bailout of Fannie Mae and Freddie Mac came after years of warnings that the two mortgage giants – which hold or guarantee about 70 percent of all U.S. mortgages, worth some $5 trillion – were ripe for a fall. Critics cautioned that their quasi-government business model, under which they serve both a profit-seeking mission and a government-subsidized public goal of fostering affordable housing, was a recipe for trouble. Conservatives are calling for Fannie and Freddie to be cut loose from government backing once their immediate financial crisis is over. But the companies continue to enjoy support among key congressional Democrats. Some experts say the broad collapse on Wall Street in the days after Fannie and Freddie’s bailout will make it hard for policy makers to move toward privatizing the two firms anytime soon. By Thomas J. Billitteri

In the wake of the government’s recent takeover of mortgage giants Fannie Mae and Freddie Mac, three of the nation’s major financial institutions were rocked to their foundations this week: Lehman Brothers, a century-old investment bank, declared bankruptcy, brokerage firm Merrill Lynch was bought by Bank of America and insurance giant AIG was bailed out by an $85 billion loan from the federal government, which in effect bought a nearly 80 percent stake in the company. All three were rocked by overexposure to subprime mortgages and related investments. Lehman Brothers’ future remains somewhat uncertain. The English financial firm Barclays bought parts of Lehman, but some divisions may remain in operation.

More infants may be affected by the contaminated milk powder that has already been linked to the deaths of three infants and to health problems in more than 6,200 others, China’s Health Ministry warned. The company at the heart of the widening scandal, Sanlu Group, apologized Monday for the tainted milk powder, which the Health Ministry said had been spiked with the industrial chemical melamine. Police have arrested four brothers in connection with the tainted milk. The scandal follows a series of product-safety scandals last year involving unsafe food, toys, tires, toothpaste and other Chinese exports. Melamine is the same chemical that contaminated pet-food exports, causing the deaths of scores of animals in the United States.

In the arid landscape near Naco, Ariz., America’s new border fence already looks timeworn. A rusted brown the color of the distant Huachuca Mountains, spray-painted here and there with directions for maintenance crews, it snakes up and down rugged hills, disappearing into the distance. Besides its length, the most surprising thing about the fence is how unimpressive it appears. Our nation’s highly publicized first line of defense against illegal entry, now being built up and down the U.S.-Mexican border, looks in some places like something that might guard a construction site.

But to Border Patrol Agent Mike Scioli the fence marks a new day. “It’s a huge improvement,” he said recently, while showing a reporter the 14-foot-high fencing near Naco and the accompanying new roads, lights and other improvements. “It makes a huge difference in our ability to do our job. It changes the game.”

A few miles away, Bill Odle, a retired Marine whose house sits only a hundred yards or so from a stretch of fence erected last fall, views the fence quite differently. Odle has lived on the border since 1997 and is familiar with the evidence and even the sight of illegal immigrants stealing across. He regularly picks up the trash they leave behind and fixes livestock fences they’ve damaged. But it’s the border fence itself that raises his ire.

“It’s ugly. It doesn’t work. It costs too much,” Odle said, contemplating the steel-mesh barrier from his driveway. “It’s the perfect government project.”

The 670 miles of barriers the government plans to have in place along the U.S.-Mexican border by the end of the year does more than separate two nations: It sharply divides U.S. opinion about how we should approach illegal immigration and border security. That division becomes evident even in what the barricade is called. The government and supporters of the structure call it a “fence”; opponents disparagingly call it a “wall.”

A March 2008 Associated Press poll found Americans almost evenly split over the Secure Border Initiative, with 49 percent favoring the fence and 48 percent opposing it. But only 44 percent believe it will make a difference, while 55 percent do not.

That sentiment may partly reflect skepticism about the effectiveness of the effort. The “fence” is really a melange of barriers – built along several different stretches of the border – designed to hamper immigrants crossing illegally on foot and in vehicles. Some of the earliest portions are solid metal, consisting of corrugated steel once used in Vietnam-era aircraft landing mats. More recent sections are often made of wire mesh reinforced by concrete-filled poles or taller concrete-filled poles planted six inches apart. The height ranges from 12 to 18 feet. Vehicle barriers are lower and often resemble the crossed metal defenses erected by the Germans on the beaches of Normandy during World War II.

The longest continuous segment is 22.5 miles, according to Barry Morrissey, a Bureau of Customs and Border Protection (CBP) spokesman. The United States had constructed 338 miles of fencing as of Aug. 13, 2008. Homeland Security Secretary Michael Chertoff has said 670 miles will be in place by the end of 2008 – stretching across about one-third of the 1,950-mile-long U.S.-Mexican border. Roughly 370 miles of the fence will be designed to stop pedestrians and 300 miles of it to stop vehicular traffic. At least 28 miles of the fence will consist of high-tech sensors and cameras that will create a “virtual fence” in parts of the Arizona desert. However, Homeland Security recently sent that project back to the drawing board after the initial effort proved neither high-tech nor particularly effective.

But even as National Guard engineering units and private contractors work to meet Chertoff’s ambitious completion timetable, everything about the fencing – from design to location to the very notion itself – has proven controversial. Some prefer a double layer of more formidable fencing along nearly the entire length of the border. Others object to the wall on humanitarian grounds, believing it only forces illegal migrants to try crossing in more dangerous or remote desert areas or along the Pacific and Gulf of Mexico coasts. In both cases, they say, the death toll – which has been climbing for years – is likely to rise further.

“The fence doesn’t stop migration along the border, it simply displaces migration,” says Nestor Rodriguez, co-director of the Center for Immigration Research at the University of Houston.

The fence has attracted a widely disparate group of opponents. A coalition of civic leaders from 19 Texas border communities has sued to halt construction, claiming the federal government has improperly seized land for the fence. The Defenders of Wildlife and the Sierra Club are trying to halt the fence because of concern over what it will to do wildlife and environmentally sensitive habitat.

“This thing might not be very effective at stopping people, but it’s stopping wildlife in its tracks,” says Matt Clark, the Southwestern representative of Defenders of Wildlife.

While critics attack from all directions, supporters concentrate their defense of the fence along two fronts: its important role in halting illegal immigration and bolstering border security at a time of increased threats from terrorists and drug smugglers.

“It sends a message we are finally getting serious about our borders,” says Rosemary Jenks, director of governmental affairs for NumbersUSA, a group that advocates reducing both illegal and legal immigration.

Few think a fence alone will stem the tide of illegal immigrants across the Southern border, estimated by the Pew Hispanic Center at about 850,000 people annually between 2000 to 2006. But supporters believe properly placed fencing, backed by more surveillance equipment and an expanded Border Patrol (projected to reach 18,319 agents by the end of 2008) can largely halt the flow of illegal human traffic.

The history of the economic, demographic and cultural forces that finally led America to fence off more than a third of its border with Mexico is nearly as long and serpentine as the fence itself. In fact, the fence can be viewed as the physical manifestation of two powerful political currents: heightened U.S. attention to national security after the terrorist attacks of Sept. 11, 2001, and a rapidly integrating global economy that has left many Americans vulnerable to competition from foreign workers, both here and abroad.

The forerunner of the fence building now under way began in a far more limited fashion near San Diego in the 1990s. Congress adopted the idea as a national approach to the border when it passed the Secure Fence Act of 2006, which called for double-layer fencing along specific sections of the border. The law was subsequently modified to give Chertoff wide discretion in where and when to install fencing.

Work is under way in all four states along the border – California, Arizona, New Mexico and Texas. But two states will get most of the barrier: Texas will get 149 miles of pedestrian fencing by the end of 2008, according to the CBP, while Arizona will end up with 317 miles (130 miles of pedestrian fencing and 187 miles of vehicular barriers), covering 84 percent of the state’s 377-mile border with Mexico.

The CBP estimates that pedestrian fencing costs about $4 million to $5 million per mile, depending on the terrain, while vehicle fencing costs $2 million to $3 million. But the Government Accountability Office (GAO) says the final costs will be higher. Although the long-term price tag is difficult to estimate, the U.S. Army Corps of Engineers predicts the 25-year cost could range from $16.4 million to $70 million per mile, depending on the amount of damage done to the fence by illegal border crossers and the elements. Thus the quarter-century cost to taxpayers for 670 miles of fence could reach as high as $46.9 billion, or nearly seven times the size of the annual budget of the Environmental Protection Agency.

Moreover, if Chertoff’s goal is to be met, construction will have to average more than a mile a day for the rest of this year. Many supporters and opponents are skeptical, but government officials are confident they’ll meet the self-imposed deadline.

“We are on track to complete this project by the end of the year,” says Jason Ahern, CBP deputy commissioner, “and then we’ll assess where we need to consider putting additional miles of fence.”

The sudden death of 58-year-old “Meet the Press” host Tim Russert in June from a massive heart attack shocked millions of middle-aged Americans.

Diagnosed with high cholesterol and high blood pressure, the gregarious NBC Washington bureau chief had been taking cholesterol and blood-pressure medications and aspirin and was told to diet and exercise, says Roger S. Blumenthal, an associate professor of medicine at the Johns Hopkins University Hospital in Baltimore.

“He exercised, but, like many other patients, he was not able to motivate himself” to diet, and “he knew that he had a tendency to overeat and to gorge when he was stressed,” says Blumenthal.

The American diet – built all too often on a shaky, fast-food foundation – leaves most of us with arteries coated with fatty plaques, especially once middle age approaches. Some of those plaques – medical science doesn’t yet know which ones – have a tendency to break away from the blood-vessel wall. Then blood cells called platelets can stick to the dislodged plaque, forming a blood clot that can trigger a heart attack.

Russert had just returned to work after a family trip to Italy when he suffered such a plaque rupture, possibly triggered by stress and lack of sleep, along with another potentially fatal complication – a heart arrhythmia. He died before he could be taken to a hospital. Although his office had a publicly accessible AED – automated external defibrillator – his colleagues waited for an ambulance crew to arrive rather than trying to shock his heart back into rhythm.

“One in every six heart attacks has sudden death as its first, last and only symptom,” says William B. Kannel, a Boston University professor of medicine and public health. And among heart-attack fatalities, nearly half are sudden-death events, he adds.

Overall, about 40 percent of both women and men die of a heart-related ailment, says Blumenthal. “Most of us face it after the age of 60.” On the plus side, he notes, the death rate is declining.

In 1999, the American Heart Association (AHA) declared a goal of reducing deaths from cardiovascular illnesses by 25 percent by 2010, “and we’re there already,” says AHA President-elect Clyde Yancy, medical director of Baylor University Medical School’s Heart and Vascular Institute in Houston, Texas. In January, data from the U.S. Centers for Disease Control and Prevention (CDC) showed coronary heart-disease death rates down by 25.8 percent and stroke deaths down 24.4 percent since 1999.

In fact, it’s “fairly likely that in the next 10 to 15 years cancer will supplant [cardiovascular disease] as the leading cause of death,” says Peter W. Groeneveld, an assistant professor of medicine at the University of Pennsylvania in Philadelphia.

Nonetheless, sedentary lifestyles and a diet heavy in saturated fats and processed carbohydrates have created several generations of young Americans vulnerable to cardiovascular disease. As a result, the downward trend in cardiovascular disease rates is expected to reverse itself in the coming decades.

“In a nation in optimal health,” adults would reach a stable health status around age 20, and then their health status “would stay relatively flat until almost the time they die,” says David Herrington, a professor of internal medicine at the Wake Forest University School of Medicine in Winston-Salem, N.C. “You’d have a very, very long period of being mobile, high-functioning and able to take care of yourself.”

But in American society, he explains, many people experience a gradual decline in health status beginning in their 50s – usually related to cardiovascular conditions, which can cause disability for 10-30 years. Due largely to unhealthy lifestyles, “We already have several generations on this trajectory” who will require “lots of care provided by friends and family, nurses, home-health workers and hospitals, which is an incredible drain on society,” he says.

William Boden, a professor of medicine and public health at the State University of New York’s University at Buffalo, agrees. “In 2008, we’re looking at the tip of the iceberg” on heart disease as a widespread illness, he says. In the next few years, two large waves of patients with cardiovascular disease will sweep through the system, beginning with the nation’s 76 million aging baby boomers – born between 1946 and 1964.

“Because of demographics, the sheer numbers [of cardiovascular diseases] are up,” says Herrington, even though the percentage of people who get the disease has declined. “The number of people who have them is astronomically large.”

The second wave of cardiovascular disease will hit between 2030 and 2050, triggered by the obesity epidemic now plaguing the nation. Two-thirds of Americans are overweight, and a growing number of adolescents are being diagnosed with Type 2 diabetes – both markers for subsequent cardiovascular disease, Boden says. “The lid is going to blow off vascular diseases, and it could bankrupt society.”

Michael A. Blazing, an associate professor of medicine at Duke University, in Durham, N.C., blames the rise in cardiovascular disease in part on the failure of the health-care and insurance industries to focus on healthier lifestyles. Such low-cost initiatives have often been ignored while medical research produced techniques to prolong lives after people have suffered a first stroke or heart attack, he explains.

“We continue to move forward in reducing risk of a second heart attack,” Blazing says. “Today 65-year-olds come in with a heart attack, and they’re golfing a week later.” But cardiovascular illnesses are long-building diseases with well-known risk factors, many of them controllable, he continues. “And the cost of providing the care only after the disease has manifested itself is becoming more and more astronomical.”

Meanwhile, nutrition counseling and other health-education efforts haven’t been reimbursed by public or private insurers, he points out, but physicians “get paid wonderfully” for opening a blocked artery.

In addition, there’s plenty of high-tech waste in the system, says Blumenthal, such as requests for sophisticated diagnostic tests that may not reveal much of significance. “Physicians shouldn’t be reimbursed for giving someone a nuclear stress test every July,” he says, because it not only costs more but also exposes patients to more radiation than traditional stress testing. State-of-the-art procedures like nuclear stress tests, which record the heart’s electrical activity, “take up a bigger and bigger part of the Medicare budget” without providing a clear return, he says.

Other physicians defend Americans’ love affair with high-tech.

“We’ve been telling patients not to eat cheeseburgers for 50 years, and they still don’t believe us,” says Andrew Rosenson, a radiologist in Oak Forest, Ill., outside of Chicago. But when patients actually see the plaque in their arteries, via a high-tech scan, “I’ve had 50-year-old CEOs sitting in my office crying,” pledging to follow the preventive regimens their doctors have long recommended in vain.

Currently, Medicare is experimenting with risk-factor reduction programs with its age-65-and-up enrollees, but such programs should be expanded to people who are 60 or younger, says Kenneth Thorpe, a professor of health policy and management at the Emory University School of Public Health in Atlanta. However, insurance companies and employers who provide health coverage for younger people see no financial benefit in offering preventive services for illnesses that, for most people, won’t become really costly until patients are old enough for Medicare, he says.

Beneficial dietary change would see people switching from McDonald’s fast-food to sweet potatoes and broccoli, says John A. McDougall, an internist in Santa Rosa, Calif., and advocate of a stringent, low-fat vegetarian diet as the only successful preventive strategy. But “there’s no support in our society for this kind of change,” he says. Rather, advertising unceasingly preaches that high-calorie food is good and that medicines are what control disease.

For proof that the health-care system ignores unhealthy lifestyles, one need only note that “in the intensive-care unit you get the same diet served to you that brought you there in the first place,” McDougall says.

“Meet the Press” moderator Tim Russert’s fatal heart attack in June tragically reminded middle-aged Americans that cardiovascular disease is the nation’s leading cause of death. One in every six heart attacks has sudden death as its first, last and only symptom. Overall, about 40 percent of both women and men die of a heart-related ailment. On the plus side, U.S. cardiovascular-disease deaths have dropped dramatically in recent years. But public health officials warn that the downward trend is about to reverse itself as two large waves of cardiovascular disease wash over the U.S. health-care system in the next several decades – one caused by the aging of the nation’s 76 million baby boomers and the other by Americans’ sedentary lifestyles and poor diet. “The lid is going to blow off vascular diseases, and it could bankrupt society,” according to one cardiovascular expert.

* Is the burden of cardiovascular disease lessening? * Can Americans make the lifestyle changes needed to eliminate cardiovascular disease? * Do we rely too much on high-tech medicine to combat cardiovascular disease?

U.S. Border FenceAmerica is rushing to build 670 miles of fencing along the U.S.-Mexican border by the end of the year. The fence, or wall, as many along the border call it, is to include 370 miles of fencing intended to stop illegal immigrants on foot and 300 miles of vehicle barriers. The Bush administration is using unprecedented authority granted it by Congress to waive environmental, historic and cultural protection laws to speed construction. No one claims that building physical barriers along roughly a third of America’s 2,000-mile southern border will stem illegal immigration by itself, but supporters believe it is an essential first step in “securing the border,” providing a critical line of defense against illegal migration, drug smugglers and even terrorists. Opponents see it as a multi-billion-dollar waste that will only shift illegal immigrants toward more dangerous and difficult routes into the country, while doing environmental, cultural and economic damage.By Reed Karaim

Gay Marriage ShowdownsThe California Supreme Court gave gay-rights advocates a major victory in May by ruling that the state’s constitution guarantees same-sex couples the same marriage rights as opposite-sex pairs. Thousands of same-sex couples from California and other states – since California does not have a residency requirement – have already taken advantage of the decision to obtain legal recognition for their unions. Opponents, however, have placed on the state’s Nov. 4 ballot a constitutional amendment that would deny marriage rights to same-sex couples by defining marriage as the union of one man and one woman. Similar proposals are on the ballot in Arizona and Florida. The ballot-box showdowns come as nationwide polls indicate growing support for some legal protection for same-sex couples, but not necessarily marriage equality. In California, early polls showed support for the ballot measure, but more recently it has been trailing. Meanwhile, marriage-equality cases are pending before state high courts in Connecticut and Iowa, with decisions expected soon. Massachusetts became the first state to legally permit gay marriage, in 2004.By Kenneth Jost

Affirmative ActionAffirmative action has sunk deep roots in American higher education, government and business. But tension still runs strong between the ideal of choosing school and job candidate purely on merit, and requirements to factor in other criteria – including race. This November, ballot initiatives in at least two states would eliminate race, but not socioeconomic, preference. And big states including California, Florida and Texas are still struggling to reconcile legal mandates restricting the use of race in college admissions with the goal of increasing diversity. One stumbling block: affirmative action didn’t lessen the stunning disparities that plague elementary and high school education, disparities that often follow the color line. Still, the open racial hostility that marked opposition to affirmative action decades ago has faded. Even some race preference critics don’t want to eliminate it entirely. Instead, they’re exploring ways to keep diversity without eroding admission and hiring standards.By Peter Katel

The last Japanese military mission may leave Iraq by the end of the year, according to the Ministry of Foreign Affairs. For two years Japan’s Air Self-Defense Force has been airlifting troops and materials between Iraq and Kuwait to support U.S.-led coalition forces. Japanese defense officials say the situation in Iraq has improved and the Iraqi government has asked countries to downsize their military presence. Japan’s first mission – the Ground Self-Defense Force – initially was deployed in 2004 to help in reconstruction. It left in 2006. An official pacifist nation since the end of World War II, Japan’s presence in Iraq has generated considerable criticism among the Japanese population.

Lehman Brothers CEO Richard S. Fuld Jr. has stepped up efforts to sell the 158-year-old investment bank. The bank had originally been planning to sell only its investment management division, but now wants to sell the entire company. The company’s stock has dropped nearly 40 percent over the past week after reports that it lost $3.9 billion in the last quarter. Earlier this year rival Bear Stearns was acquired by JPMorgan Chase with the assistance of the Federal Reserve Bank after Bear teetered on the edge of bankruptcy. Potential buyers for Lehman include several other investment banks as well as private equity companies.

U.S. troops are using new tactics in Iraq and Afghanistan. Instead of trying to defeat the enemy by brute force, they are focusing on counterinsurgency – protecting civilians and relying on them to provide information on enemy activity. But some military experts argue that too much emphasis on “winning hearts and minds” is weakening the skills needed in conventional combat – from rapid infantry advances to accurate artillery marksmanship to tank tactics. Counterinsurgency advocates concede that some of these capabilities may decline, partly because U.S. foes on today’s Third World battlefields don’t have air power or armor. Still, they say no sane enemy would challenge the powerful U.S. military in a traditional, World War II-style conflict. But even battle-hardened veterans of today’s conflicts acknowledge that military forecasting is an inexact science and that the biggest danger can be planning ahead – for last year’s war.

• Is counterinsurgency the next wave of warfare?• Should the Army form an advisers corps?• Is the emphasis on counterinsurgency weakening the military?

Heart HealthThe shocking death of 58-year-old “Meet the Press” host Tim Russert in June from a sudden heart attack was all-too-common for middle-aged Americans. One in every six heart attacks has sudden death as its first, last and only symptom. Overall, about 40 percent of both women and men die of a heart-related ailment. But there is some good news: The cardiovascular-disease death rate has been dropping. In 1999, the American Heart Association declared a goal of reducing deaths from cardiovascular illnesses by 25 percent by 2010 – a goal that already has been reached. In January, coronary heart-disease death rates were down by 25.8 percent, and stroke deaths were down 24.4 percent. But heart-related health troubles are far from over. Despite steady progress for the past 60 years, sedentary lifestyles and a diet heavy on saturated fats and processed carbohydrates like non-whole-grain flour have taken a toll on Americans’ health. There are now several generations of Americans at risk for cardiovascular disease over the next several decades. By Marcia Clemmitt

U.S. Border FenceAmerica is rushing to build 670 miles of fencing along the U.S.-Mexican border by the end of the year. The fence, or wall, as many along the border call it, is to include 370 miles of fencing intended to stop illegal immigrants on foot and 300 miles of vehicle barriers. The Bush administration is using unprecedented authority granted it by Congress to waive environmental, historic and cultural protection laws to speed construction. No one claims that building physical barriers along roughly a third of America’s 2,000-mile southern border will stem illegal immigration by itself, but supporters believe it is an essential first step in “securing the border,” providing a critical line of defense against illegal migration, drug smugglers and even terrorists. Opponents see it as a multi-billion-dollar waste that will only shift illegal immigrants toward more dangerous and difficult routes into the country, while doing environmental, cultural and economic damage. By Reed Karaim

Gay Marriage ShowdownsThe California Supreme Court gave gay-rights advocates a major victory in May by ruling that the state’s constitution guarantees same-sex couples the same marriage rights as opposite-sex pairs. Thousands of same-sex couples from California and other states – since California does not have a residency requirement – have already taken advantage of the decision to obtain legal recognition for their unions. Opponents, however, have placed on the state’s Nov. 4 ballot a constitutional amendment that would deny marriage rights to same-sex couples by defining marriage as the union of one man and one woman. Similar proposals are on the ballot in Arizona and Florida. The ballot-box showdowns come as nationwide polls indicate growing support for some legal protection for same-sex couples, but not necessarily marriage equality. In California, early polls showed support for the ballot measure, but more recently it has been trailing. Meanwhile, marriage-equality cases are pending before state high courts in Connecticut and Iowa, with decisions expected soon. Massachusetts became the first state to legally permit gay marriage, in 2004. By Kenneth Jost

Republican presidential nominee John McCain selected Alaska Gov. Sarah Palin as his vice presidential running mate. Palin’s dynamic acceptance speech energized this week’s Republican National Convention in Minneapolis with withering and often sarcastic criticism of Democratic nominee Barack Obama. She is the first ever female Republican nominee on a major presidential ticket and only the second woman in the history of the United States; N.Y. Rep. Geraldine Ferraro was Democratic candidate Walter Mondale’s running mate during the 1984 election. The controversial nominee appeared with her husband and five children, including her unmarried, pregnant daughter Bristol.

A 19-square-mile ice shelf in Canada’s Arctic region has broken away while remaining shelves have shrunk at what scientists are calling a “disturbing” rate. The separation of the Markham Ice Shelf – one of just five ice shelves in the region – from Ellesmere Island is being blamed on accelerating climate change in the Arctic. Studies show that temperatures in the Arctic have risen faster than the global average in recent decades and threaten the remaining ice shelves. Two large chunks of ice totaling 47 square miles have also recently broken off from the nearby Serson Ice Shelf, reducing its size by 60 percent.

The Department of Energy has allowed Venezuelan-controlled Citgo to pull 250,000 barrels of oil from the Strategic Petroleum Reserve because of its inability to secure crude oil in the aftermath of Hurricane Gustav. Supplies to its refinery in Lake Charles, La., were cut off following the closure of the Calcasieu Ship Channel. Citgo’s request is so far the only request for fuel from the reserve following Gustav. The reserve is an emergency depot maintained by the Department of Energy that can hold more than 700 million barrels of oil in salt caverns scattered around the Gulf of Mexico.

Early this summer, after savage fighting, elements of the 24th Marine Expeditionary Unit forced Taliban fighters out of Afghanistan’s HelmandValley, an area they had dominated for two years. Now it was time to talk.

The commander of Alpha Company, from the 6th Marine Regiment’s First Battalion, Capt. Sean Dynan, a soft-spoken Annapolis graduate and fourth-generation fighter, addressed wary members of the village council in Amir Agha.

“I know that all of you want to just live your lives and that you don’t want us to interfere with what you’re doing on a daily basis,” Dynan told two dozen men gathered in the marketplace. “It is our intention to help and to protect you.”

But making friends was proving difficult in a country at war since the failed Soviet occupation of the 1980s. “America came here telling us they’re going to help us, but these are all tricks, the same tricks that Russia played – then they started killing us,” Sayid Gul, an opium-poppy grower and merchant, told Bill Gentile, a PBS journalist embedded with the Marines. “We don’t trust them any more, the foreigners.” Gul was trying to get the Marines to pay him for damaging his house during a battle with the Taliban.

Despite the villagers’ wariness, Dynan’s efforts at on-the-ground diplomacy reflect the Pentagon view that similar counterinsurgency tactics have led to a notable lessening of violence in Iraq this year.

Support for counterinsurgency is a key tenet of Defense Secretary Robert M. Gates’ new National Defense Strategy, which lays out a hearts-and-minds approach for the last phase of what the Bush administration once labeled the “global war on terror” and now dubs “the long war.”

“Military efforts to capture or kill terrorists are likely to be subordinate to measures to promote local participation in government and economic programs to spur development,” the document says, “as well as efforts to understand and address the grievances that often lie at the heart of insurgencies.”

That strategy may sound more Peace Corps than Army and Marines. But counterinsurgency advocates argue they’re guided by practicality, not bleeding-heart humanitarianism. Even after major fighting ends in Iraq and Afghanistan, the United States and its allies will be facing so-called asymmetric conflicts against foes who know every nook and cranny of their home terrains, says John A. Nagl, a newly retired Army lieutenant colonel and leading counterinsurgency expert, now a senior fellow of the nonpartisan Center for a New American Security. He has proposed the formation of a 20,000-strong corps of Army advisers to work with U.S.-friendly governments facing insurgencies or potential insurgencies.

“Our conventional superiority is going to drive our enemies to fight us asymmetrically,” says Nagl, who served as operations officer of an armored battalion early in the Iraq War and later helped write the U.S. Army-Marine Corps Counterinsurgency Field Manual. But that doesn’t mean U.S. troops will be sitting ducks for traditional military operations, he says. “Even understanding that we’ve been focusing on counterinsurgency, you’re still not going to want to mass tanks against the United States,” he says, because American pilots would make short work of enemy armor.

Beware of such certainties, some military experts warn. One of the most vocal skeptics, Iraq combat veteran Lt. Col. Gian P. Gentile, argues that counterinsurgency advocates have drawn a false distinction between full-on, World War II-style combat and asymmetrical warfare. Recent events, he says, show that these varieties of combat can be used simultaneously.

As an example, Gentile points to Israel’s painful experience in Lebanon during the 34-day war in the summer of 2006. Israeli troops who had been using counterinsurgency tactics in the Palestinian territories unexpectedly found themselves facing Hezbollah fighters in Lebanon employing conventional military tactics instead of guerrilla warfare to defend their territory. Hezbollah killed 119 Israeli soldiers, a shockingly high death toll for Israel.

“I use that as a way to think about conflicts the United States might face in the future,” says Gentile, who commanded an armored reconnaissance squadron in Baghdad in 2006, often confronting unseen enemies. Now a history professor at the United StatesMilitaryAcademy at West Point, he notes that the United States must continue to be ready in the future to deal with potential foes, such as Iran and North Korea, with big conventional armed forces.

After Gentile spoke, the Aug. 8 Russian invasion of the Republic of Georgia, a strong U.S. ally, prompted a wave of speculation about a rebirth of the Cold War – a period during which U.S. and Soviet forces trained incessantly for full-scale conflict in Europe. But, for now, at least, Secretary Gates said, “I don’t see any prospect for the use of military force by the United States in this situation.”

In fact, the counterinsurgency-versus-conventional-warfare debate first began during the Cold War years, long before Gentile and Nagl – who both hold doctoral degrees – won their combat decorations in Iraq.

President John F. Kennedy came into office in 1961 determined to challenge Soviet-sponsored guerrilla insurgencies in societies scarred by colonialism or social injustice. Kennedy expanded the limited U.S. advisory effort in Vietnam, pushing for greater use of the military’s “unconventional warfare” unit, Army Special Forces. But after Kennedy’s assassination, the conflict turned into a full-scale war that emphasized the conventional-war strategy known as “attrition” – trying to force surrender by killing large numbers of enemy troops.

Military experts and historians still argue over whether attrition would have succeeded if the U.S. public hadn’t forced an end to the war, or whether an early and total commitment to counterinsurgency warfare would have turned the tide. In any case, from the end of the Vietnam War until 2001, U.S. counterinsurgency operations were mounted as advisory missions – not major troop commitments – as in El Salvador during the 1980s. Indeed, the biggest post-Vietnam military operation, the Persian Gulf War of 1991, followed conventional lines – massive forces of aviation, artillery and armored infantry deployed against another nation-state’s military.

Conventional warfare also dominated the early phase of the Iraq War, though Defense Secretary Donald H. Rumsfeld modified it by demanding use of a relatively small, highly mobile ground force, reinforced by massive airpower.

The planning focused solely on toppling Saddam Hussein and defeating his forces, not on what would follow the invasion. “We are not in Iraq to engage in nation-building,” Rumsfeld wrote in The Washington Post six months after the U.S. invasion in March 2003. “The sooner Iraqis can take responsibility for their own affairs, the sooner U.S. forces can come home.”

But nation-building found favor in the Bush administration after U.S. forces came under attack both from Sunnis and Shiites in the years following the invasion.

Nation-building and counterinsurgency are closely related. “Counterinsurgency is nation-building in the face of armed opposition,” in Nagl’s definition. The Bush administration signaled its new strategy with the 2007 appointment of a new top commander for Iraq, Gen. David H. Petraeus, who co-directed preparation of the 2006 U.S. Army-Marine Corps Counterinsurgency Field Manual, the first publication of its kind for more than 20 years.

Petraeus made his first priority the protection of Iraqi civilians, a shift in emphasis from pouring all resources into hunting and killing enemies.

For American military personnel, deaths have fallen to 221 in the first seven months of 2008 – from 740 during the same period last year. Meanwhile, deaths among Iraqi security forces and civilians have fallen from more than 14,000 during the first seven months of 2007 to about 4,300 during the same period in 2008.

One of Petraeus’ key tactics was forging ties with Sunni tribes who were rebelling against the group Al Qaeda in Iraq and eroding the power of militias on whom Shiite civilians had depended for protection. As a result, says military-affairs specialist Stephen Biddle, who served on Petraeus’ staff in 2007, “By late 2007 you had a situation in which all major internal combatants, for perfectly rational, perfectly self-interested reasons, had declared cease-fires – observing ceasefires of necessity.” Biddle is a senior fellow at the Council on Foreign Relations think tank.

Skeptics argue, however, that counterinsurgency strategy had little to do with the increasing stability – because the United States never faced a true insurgency in Iraq or in Afghanistan. “We’re not defending legitimate governments against foreign-inspired insurgencies,” says Douglas A. Macgregor, a former Army colonel who served in the Persian Gulf War. “We’ve established puppet regimes designed to implement our will, and provoked rebellions against those regimes.” Macgregor now consults for the defense industry and writes on military affairs.

Still, says Carter Malkasian, a military expert who has advised Marines in Iraq and Afghanistan, precisely labeling U.S. strategy and the nature of the war in Iraq matters less than the ultimate result. “What wins wars?” he asks. “There’s very powerful argument to be made that tactics are much less important than economics and politics.” In Iraq, Sunni tribes’ turning against Al Qaeda in Iraq proved more decisive than U.S. strategy, he says.

Moreover, argues Air Force Maj. Gen. Charles J. Dunlap Jr., treating counterinsurgency largely as a low-tech exercise of winning the trust of poor villagers downplays what modern air power can accomplish.

“In the early part of the Afghanistan war, the Taliban assumed we would fight like the Russians, and they could simply hold out,” Dunlap says. “What the Taliban didn’t know about was the advent of laser-guided and precision munitions. Suddenly they’re in positions they’ve held for years, and their foxholes are being vaporized by B-52s they didn’t see or hear. What unhinges an adversary is knowing that he’s helpless against his opponent’s weapons.”

Nevertheless, air power without solid intelligence on the ground can be catastrophic. In late August, U.N. investigators and an Afghan government commission said a U.S. air strike in western Afghanistan had killed 90 civilians, including 60 children. The U.S. military said 30-35 insurgents, including a Taliban commander, had been killed, along with five to seven civilians. But two members of the Afghan parliament said tribal enemies of the targeted community had fed false information to the U.S. military about a Taliban presence.

Gen. David D. McKiernan, U.S. commander of the NATO force in Iraq, countered later that the civilian casualty number had been deliberately inflated. “We regret the loss of civilian life, but the numbers that we find on this target area are nowhere near the number reported in the media. We believe there was a very deliberate information operation orchestrated by the insurgency, by the Taliban,” he told The New York Times.

Taliban adaptability to U.S. tactical and strategic shifts helps explain the insurgents’ comeback of the past several years.

Even so, Gul and his fellow villagers could be forgiven for still keeping the Americans at arms’ length. Soon after the Marines entered the village of Amir Agha, they were led to the body of a man lying on a path, his throat slit. The message, villagers said, was clear: Don’t cooperate with the Americans.

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